Self-neglect

The Care and support statutory guidance (2025) defines self-neglect as:

‘a wide range of behaviour neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding. It should be noted that self-neglect may not prompt a section 42 enquiry. An assessment should be made on a case by case basis. A decision on whether a response is required under safeguarding will depend on the adult’s ability to protect themselves by controlling their own behaviour. There may come a point when they are no longer able to do this, without external support.’

Self-neglect can be challenging for practitioners to address, because of the need to find the right balance between respecting an adult’s autonomy and fulfilling a duty to protect the adult’s health and wellbeing.

Indicators of self-neglect

Poor personal hygiene
Unkempt appearance
Lack of essential food, clothing or shelter
Social withdrawal from family/ community/ support networks
Malnutrition and/or dehydration
Living in squalid or unsanitary conditions
Neglecting household maintenance
Hoarding
Non-attendance at health or other care appointments
Unable to take medication or treat illness or injury
Unable to protect self from harm or abuse
Morbid obesity where there may be links to self-neglect and trauma, resulting in less ability to self-care.

What can lead to self-neglect

Adults may self-neglect and/or hoard for a number of reasons and there can be a variety of triggers (this list is not exhaustive):

Brain injury, dementia or other mental disorder
Self-care is one of many competing priorities
Obsessive compulsive disorder or hoarding disorder
Addiction to substances impacting on executive functioning
Childhood neglect/ childhood trauma/ adverse childhood experiences with trauma lasting through to adulthood which impact upon their current decision making
Trauma or life changing events experienced during adult hood e.g. bereavement
Physical illness which has an effect on abilities, energy levels, attention span organisational skills or motivation
Reduced motivation as a side effect of medication
The loss of independence as a result of an accident, trauma, major ill health or frailty

The Torbay and Devon Safeguarding Adults Partnership undertook a Thematic Review on Self Neglect which was published in 2023 and highlighted learning for all partner agencies when working with adults who present with self-neglect behaviours.

Refreshed guidance have been produced which can be accessed here:

TDSAP Guidance to support partnership working with adults who present with self-neglect behaviours

TDSAP Guidance to support partnership working with adults who present with hoarding behaviours

The guidance include helpful appendices and tools to promote person-centred, proportionate responses aligned with the Care Act 2014 and draws on learning from local Safeguarding Adults Reviews.

Watch the TDSAP self-neglect animation

Lambeth Safeguarding Adults Board launched an animation in 2020 which also highlights the challenges faced when working with an adult who present with self-neglect behaviours. The key messages from this animation resonate with the lessons learned from Torbay and Devon Safeguarding Adults Reviews. Lambeth Safeguarding Adults Board Self-Neglect Animation Video

Newcastle Safeguarding Adults Board produced a short animation which aims to promote essential principles in positively engaging adults Eight Principles of Engagement

For further top tips when supporting an adult who is presenting with self-neglect or hoarding behaviours, please view the Care Knowledge Self-Neglect and Hoarding toolkit

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